Utilization Growth and Reimbursement Decline in Spine Surgery: A Retrospective Analysis Using National Medicare Data...

Spine disorders are among the most common causes of disability, with utilization of spine procedures nearly doubling over the past 2 decades. As costs have continued to escalate, the Centers for Medicare & Medicaid Services have implemented bundled care initiatives and reimbursement reductions, leading to declining physician payment. This study provides a comprehensive summary of utilization and reimbursement for the most common spine procedures using a large national insurance database.

Patient data from 2010 to 2021 were accessed by querying the national insurance claims database using Current Procedural Terminology codes. After identifying the 10 most used spine procedures, the Physician Fee-Schedule Lookup Tool from the Centers for Medicare & Medicaid Services was queried to obtain Medicare physician reimbursement for the procedures (2012-2024). Dollar values were adjusted using the Consumer Price Index and are reported in 2024 US dollars. Yearly reimbursement was separated by procedure type and location. Utilization trends and demographic data were also obtained.

From 2012 to 2021, 347,053 Medicare patients underwent 1 of the top 10 spine procedures, with fusion, laminectomy, and laminotomy being the most utilized. The average patient was 69 ± 8 years; 52.9% were women, with an average Elixhauser Comorbidity Index of 4.9 ± 3.7. Overall utilization increased by 19% (P = 0.04), with cervical and lumbar procedures rising by 30.61% (P = 0.01) and 19.97% (P = 0.04), respectively. Despite increased utilization, inflation-adjusted Medicare reimbursement significantly declined across all procedure types, with lumbar procedures experiencing the greatest reduction (-28.56%, P < 0.001). The largest annual decline occurred from 2021 to 2022 (-7.67% fusion and -7.52% decompression).

Despite the growing utilization of all included procedures, the present data have demonstrated a decrease in Medicare reimbursement across all subgroups.

These reimbursement trends shape the field of spine surgery, impacting the sustainability of spine practices, affecting patient access to care, and influencing the adoption of new technologies.